When are You Ready to Drive After an Injury?
Doctors, States, and Patients Vary in Handling Driving After Injury
Research from Harvard University’s Beth Israel Deaconess Medical Center in Boston published in the Journal of Bone and Joint Surgery shows a great variation in how doctors, patients, and state officials handle the question of when it is safe for someone to resume driving.
“Deciding when a patient can return to driving is a difficult decision that may require information that is beyond what is commonly available to the treating physician,” says lead researcher Edward Rodriguez, an orthopedic surgeon. “Driving is a multi-system task and although we as orthopedic surgeons may be able to tell when a limb is strong enough to endure the physical demands of driving, many times there are other concerns that vary from patient to patient. At the same time, not being able to drive can result in substantial inconvenience and financial hardship, so patients may be eager to drive before they are ready.”
To understand physicians’ concerns, Rodriguez surveyed 41 of 44 participating orthopedic surgeons during a 2007 New England Trauma Summit. Participants were anonymously polled on their recommendations on return to driving following specific injury patterns. Decision-making on clearing a patient to drive was also surveyed, as well as attitudes toward liability. A second survey was given to 330 patients returning for follow-up in Rodriguez’ practice and yielded 70 usable responses. The patients were anonymously polled on their experiences and attitudes regarding return to driving following a musculoskeletal injury or orthopedic surgery.
Doctors Vary in What They Do to Clear Patients to Drive
Rodriguez says the 41 orthopedic surgeons varied substantially on how long they waited before telling patients they could resume driving. Various criteria for assessing a patient’s ability to return to driving were reported, and some surgeons reported more than one assessment criterion.
Some 68% said they tell patients to practice driving in a parking lot until they feel comfortable, while 13% suggest seeking clearance from their physical therapist, 20% ask patients to be off narcotic medication before driving, and 12% allow patients to drive when they resume full weight-bearing and when they no longer need assistive devices. One doctor recommended that patients take a state driving test and one referred patients to a driving laboratory simulator maintained at his institution’s occupational therapy department.
The survey found that 68% of the surgeons are uneasy in telling patients they can drive again and 44% said they were concerned about potential litigation if a patient were in a collision after being allowed to drive. However, only 3% were aware of actual litigation in their geographical practice area involving a return-to-driving case. Three-fourths of the surgeons surveyed reported that they did not have a return-to-driving policy that they follow consistently.
Patients Have Problems if They Can't Drive
Nearly half (42%) of the patient respondents said that the inability to drive presented a major difficulty. To varying degrees patients relied on friends, family, and public transportation for rides, with 26% saying the inability to drive presented a major financial hardship beyond the hardships due to their injury.
Many patients did not consult with their doctors before driving, found initial opposition by their doctors regarding their return to driving, had begun driving while still on narcotic pain medications, or at times felt unsafe when driving because of their injuries. While 82% of patients who were not yet driving when surveyed said they would consult with their doctor for permission before they resumed driving, only 64% of those who were already driving had actually done so.
Rodriguez says the patient responses suggest that the inability to drive following a musculoskeletal injury or orthopedic surgery can present a substantial inconvenience as well as a financial difficulty and that may explain why patients often resume driving while still taking narcotic pain medications and without consulting their doctor. And the physician responses suggest that the return-to-driving decision is of concern to orthopedic surgeons from both a safety and a medico-legal perspective.
Document Policy and Implementation
Any policy implemented by a doctor or practice group should be well documented, printed, and clearly stated to patients early in the doctor-patient relationship, Rodriguez says. He recommends that the discussion take place before the patient raises the question of driving again.
“It should not be so inflexible that it precludes from driving the patients who may not be at risk,” he says, “but it should be universally applied to all patients. In our practice we no longer ‘clear’ patients for driving in the way that has traditionally been done in the past. We offer patients advice as to when they may be ready to retest with the Department of Motor Vehicles and then allow them to follow-through with this recommendation at their own discretion. Once a patient has reached this point, medical record documentation is made by stating that the patient ‘has improved to the point that he/she may drive again but was requested to recertify before doing so.’ As an alternative, we can provide a referral to one of two return-to-driving programs managed by independent occupational therapy services in the Boston area, where our practice is based. These programs are not affiliated with our institution and their service may not always be covered by insurance providers.”
Rodriguez’ policy is printed in a patient introduction brochure given to all trauma patients and their families on first contact with the orthopedic trauma service. He says patients have been generally supportive. While elderly patients have sometimes complained, their family members usually have appreciated the recommendations.
Asked how realistic patients are in assessing their readiness to resume driving, Rodriguez says there is wide variation, with some patients very realistic and some totally unrealistic. “They look to the doctor to set them straight,” he says, “and problems occur when the doctor’s answer doesn’t meet their expectations.”
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